Central retinal artery occlusion and ophthalmoplegia following spinal surgery

Halfon, Matthieu; Bonardo, P; Valiensi, S; Zaffaroni, Mauro; Pardal, M M Fernandez; Ayerza, D Ribero; Ebner, Roberto; Anderson, Peter; Reisin, Ricardo

doi:10.1136/bjo.2003.039651

Cited by 24 publications

(25 citation statements)

References 10 publications

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“…Our patinet's brain MRI and MRA showed no evidence of cavernous sinus thrombosis and revealed only mild periorbital swelling and enlargement with hyperintensity of the extraocular muscles in the right eye while sparing the tendons. Thus our case is believed to be similar to those reported by Halfon et al5…”

Section: Discussionsupporting

confidence: 93%

“…CRAO with ophthalmoplegia has been more infrequently reported 2-5. Hollenhorst et al3 noted that the five most severe cases out of eight cases who had proptosis, ptosis, and paralysis of the extraocular muscles improved, even though there was no visual recovery.…”

Section: Discussionmentioning

confidence: 99%

“…However, visual loss with total ophthalmoplegia as a surgical complication has rarely been described as a consequence of prolonged compression of the eye 2-5. There have been no case reports in the literature to date of visual loss following spinal surgery in Korea.…”

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confidence: 99%

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Visual Loss in One Eye after Spinal Surgery

Chung

Son

2006

Korean J Ophthalmol

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PurposeTo report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position.MethodsA 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia.ResultsDespite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up.ConclusionsA prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Visual Loss in One Eye after Spinal Surgery

Chung

Son

2006

Korean J Ophthalmol

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“…Muscles are relaxed under GA in the prone position, such that shoulder and cervical dislocations have been mentioned (2,27). In addition, optic neuropathy and blindness have been reported (8,10). However, we did not observe any neurological complication in GA patients in terms of intraoperative positioning.…”

Section: Discussionmentioning

confidence: 62%

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

Dağıstan¹,

Ökmen²,

Dağıstan³

et al. 2014

Turkish Neurosurgery

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AIm:To compare the safety and efficacy of spinal anesthesia (SA) in patients undergoing lumbar microdiscectomy (LM). mAterIAl and methOds:We evaluated 180 patients who underwent LM between 1 January 2012 and 5 July 2013. Demographic, clinical, laboratory, and pre-, intra-, and postoperative information was determined from the patients' medical records. results:Total anesthetic times were longer in the general anesthesia (GA) group. There was less bleeding at the surgical site in the SA group. Intraoperative blood pressure was significantly also lower in the SA group. Meanwhile, tachycardia was significantly higher in the GA group. The analgesic requirement in post-anesthesia care unit (PACU) was higher in the general anesthesia group. At PACU admission, analgesic requirement, heart rate, and the mean arterial pressure were higher in the GA group. Postoperative nausea and vomiting was more frequent among patients recovering in general anesthesia group. SA patients had an increased incidence of urinary retention compared with GA patients. Pulmonary complications requiring specific treatment were insignificantly higher among GA patients. COnClusIOn:In patients who undergo lumbar disc surgery, SA is a good alternative for experienced surgeons because of a more comfortable healing process.

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“…However, numerous well-known complications have been reported from prone patient positioning, such as pressure induced skin necrosis [4][5][6][7][8][9][10][11][12], and ocular complications like conjunctival [13] and corneal abrasions [14,15], postoperative visual loss (POVL) due to central retinal artery occlusion [1,2,5,[16][17][18][19], ophthalmoplegia [2,[20][21][22][23] and acute angle closure glaucoma [24]. Many of these complications are related to prolonged direct pressure over the contact areas.…”

Section: Discussionmentioning

confidence: 99%

Modified prone position using lateral brace attachments for cervico-dorsal spine surgeries

2013

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Purpose The purpose of the study was to propose a method of prone positioning for posterior cervico-dorsal spine surgeries that is easy to achieve without additional equipment and may reduce complications associated with prone positioning in patients. Methods 41 patients underwent posterior spine surgeries using our method of prone positioning on a fluoroscopy compatible conventional operation table, and the technical difficulties and complications associated were noted. After induction under general anaesthesia in supine position, cervical tongs were applied. An assembly of two adequately padded cylindrical bolsters and two lateral brace attachments was set on a conventional operating table. The patient was then positioned prone so that the tongs as well as insertion pins of the tongs rest on the lateral brace attachments, with the face and head suspended freely in between. A neutralisation weight was then applied suspended from the tongs to stabilize the head. Results The time required for patient positioning was noted and was found to be nearly the same as that required for traditional prone positioning. No problems were noted during patient positioning and with anaesthesia tubing management. All surgeries went well without position related complications except for one patient who developed post-operative macroglossia. All cervical tong pin sites healed without any complications. The fluoroscope easily gained access to the operative areas.Conclusions Our modification appears simple, versatile and reproducible for posterior approach procedures of the cervical and upper dorsal spine in prone position. Also, the method can be easily implemented in most conventional operating room facilities with minimal surgeon effort and without the need for any additional inventory.

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Central retinal artery occlusion and ophthalmoplegia following spinal surgery

Cited by 24 publications

References 10 publications

Visual Loss in One Eye after Spinal Surgery

Visual Loss in One Eye after Spinal Surgery

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

Modified prone position using lateral brace attachments for cervico-dorsal spine surgeries

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